- VNS Health (Manhattan, NY)
- …state and federal regulatory requirements related to all aspects of grievances and appeals for Medicare managed care organizations, Medicaid , home health care, ... New York State (Fair Hearings), Centers for Medicare and Medicaid Services (CMS), Independent Review Entities and Quality Improvement...Attends Fair Hearings in person with the Grievance and Appeals ' RN Specialist and presents arguments in… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist LVN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Nurse Specialist LVN II...assigned. Prepare complaint files for Centers for Medicare and Medicaid Services (CMS), Department of Health Care Services (DMHC),… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will...of complaints in compliance with Centers for Medicare and Medicaid Services (CMS), California Department of Health Care Services… more
- VNS Health (Manhattan, NY)
- …state and federal regulatory requirements related to all aspects of grievances and appeals for Medicare managed care organizations, Medicaid , home health care, ... OverviewResolves grievances, appeals and external reviews for one of the...New York State (Fair Hearings), Centers for Medicare and Medicaid Services (CMS), Independent Review Entities and Quality Improvement… more
- TEKsystems (Austin, TX)
- Description: Job Summary: The Revenue Cycle Denials and Appeals Specialist will be responsible for building and maintaining collaborative and productive ... the designated revenue cycle function, with a focus on Denials and Appeals * Performs analysis, identifies trends, presents opportunity areas, and prioritizes… more
- Houston Methodist (Houston, TX)
- …Revenue Cycle experience** At Houston Methodist, the Accounts Receivable (AR) Appeals Denials Specialist position is responsible for reviewing accounts ... S Fry Katy, TX 77450** **Looking for candidates with the following:** + ** Appeals with hospital accounts** + **Epic experience is a plus** + **Government Advantage… more
- Carle (Urbana, IL)
- Outpatient Denial/ Appeals Specialist - RN + Department: Revenue Cycle - CFH_10_19 + Entity: Champaign-Urbana Service Area + Job Category: Clerical/Admin + ... challenged. Responsible for enterprise wide outpatient clinical review and appeals on Medicare and Medicaid RAC, PERM,...clinical review and appeals on Medicare and Medicaid RAC, PERM, CERTs, etc. audits. Assists account representatives… more
- TEKsystems (Charlotte, NC)
- Description: The Revenue Cycle Denials and Appeals Specialist will be responsible for building and maintaining collaborative and productive relationships within ... the designated revenue cycle function, with a focus on Denials and Appeals * Performs analysis, identifies trends, presents opportunity areas, and prioritizes… more
- UCLA Health (Los Angeles, CA)
- Description As the Appeal & Grievance Specialist , you will be responsible for: + Managing the intake and resolution of member and provider appeals and grievances ... in compliance with CMS (Centers for Medicare & Medicaid Services) regulations for Medicare Advantage plans + Ensuring that all cases are processed within mandated… more
- TEKsystems (Boise, ID)
- …Cycle specialists to support a growing healthcare company! As a rev cycle specialist on our team you will be verifying insurance information, following up, doing ... you have experience working within medical insurance roles handling claims, payer portals, appeals , AR follow up, denials or anything within revenue cycle we would… more
- UNC Health Care (Goldsboro, NC)
- …the health and well-being of the unique communities we serve. Summary: The Medicaid Eligibility Specialist screens, coordinates and facilitates the Medicaid ... who meet the eligibility criteria. Obtains eligibility for patients entitled to Medicaid for the purpose of obtaining reimbursement for services provided by Wayne… more
- Bear Mountain Health Care (MA)
- …Home Medicaid EXPERT? Bear Mountain Healthcare is currently seeking a full time Medicaid Pending Specialist to assist in the completion of Medicaid ... facilities in Massachusetts. Duties include: . Responsible for working Pending Medicaid applications and re-determinations in order to ensure financial eligibility.… more
- MetroHealth (Cleveland, OH)
- …opportunities to improve documentation accuracy. Reviews DRG downgrades and strategic CDI appeals , and responds to payor audits and inpatient downgrade requests when ... addition to experience noted below. Minimum of 5 years as Clinical Documentation Integrity Specialist or; - CDIP or CCDS Certification with minimum of 3 years of CDI… more
- HCA Healthcare (Nashville, TN)
- …Unlock your potential! **Job Summary and Qualifications** The Clinical Review Specialist is responsible for performing retrospective medical reviews based on patient ... a retrospective review of medical records using clinical expertise and Medicaid guidelines to determine medical necessity for emergent inpatient admissions and… more
- Priority Health Care (Marrero, LA)
- JOB SUMMARY: The Revenue Cycle Specialist II must adhere to the Code of Ethical Conduct and foster positive relationships within the company, across departments, and ... response from third-party payors, processing payor denials, documentation requests, and appeals , and monitoring day-to-day activities related to appeal follow-up and… more
- The Wesley Community (Saratoga Springs, NY)
- …with family, Elevate, Summit etc. and ensure NAMI's are being billed on all Medicaid pending cases. Billing Specialist Requirements : + High School graduation or ... Billing Specialist Full Time | Day Shift | 8am-4:30pm...complete. + Produce, review and mail monthly private pay/resident income/ Medicaid Pending statements for Wesley and Woodlawn + Follow… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Revenue Cycle Specialist is responsible for providing direct and indirect revenue cycle support to the Revenue Cycle Managers. It is ... identified by the Revenue Cycle Managers. In addition, the Revenue Cycle Specialist is responsible for resolving all outstanding third-party primary and secondary… more
- Tarrytown Rehabilitation & Nursing Center (Everett, MA)
- CLINICAL REIMBURSEMENT SPECIALIST / MULTI FACILITY We offer competitive compensation and benefit plans including: + Competitive Pay + Medical, Dental, Vision ... Team, and Atmosphere! We are seeking an experienced Clinical Reimbursement Specialist to support our MDS/MMQ teams in Massachusetts. The Clinical Reimbursement… more
- Robert Half Accountemps (Dallas, TX)
- …We are offering a contract to permanent employment opportunity for a Medical Billing Specialist based in Dallas, Texas. The individual will be a part of our ... on Wheels accounts. * Following up on missing authorizations, billing issues, and appeals . * Reviewing and addressing issues related to LTC accounts with the… more
- Louisiana Department of State Civil Service (Bossier City, LA)
- Medical Certification Specialist 2 (Waiver Services) Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4715865) Apply Medical Certification ... Specialist 2 (Waiver Services) Salary $5,477.00 - $9,856.00 Monthly...the medical/social segment of the patient review process for Medicaid Waiver Services. **Note regarding the pay range: The… more